Checklist Cover Sheet
Candidate’s Last Name_____________________________________
CHECKLIST COVER SHEET
This form is to be the first page of all nominations. All items must be attached and all certifications completed. Please photocopy this form as needed for submission of your nominations.
CANDIDATE'S FULL NAME: ___________________________________________________
CANDIDATE'S CAMPUS: _______________________________________________________
FULL POSITION TITLE: ________________________________________________________
DATE OF HIRE FOR THIS POSITION: ____________________________________________
CANDIDATE'S DEPARTMENT: _________________________________________________
CHECK THE PROGRAM TO WHICH THE NOMINATION IS BEING SUBMITTED
□ Excellence in Faculty Service
□ Excellence in Librarianship
□ Excellence in Professional Service
□ Excellence in Scholarship and Creative Activities
□ Excellence in Teaching
ENDORSEMENT OF CAMPUS PRESIDENT (REQUIRED)
I certify campus endorsement of this nomination and compliance with program requirements.
President's Signature Date
President's Telephone Number
MATERIALS SUBMITTED IN CONJUNCTION WITH THE NOMINATION
The documentation identified below is required as part of the nominee’s dossier. Please verify its inclusion in the nomination packet by checking the appropriate boxes.
□ President's Transmittal Letter □ Summary Presentation
□ Description of Nomination Procedures □ Current Curriculum Vita
Please type the name and telephone number of the individual to be contacted in case questions regarding the nomination arise. The campus is to identify a single individual as the designated contact for all nominations submitted.
Name & Title ________________________________ Phone Number ____________________
Please certify campus compliance with the Policies and Procedures by checking each of the certifications below. (Please do not include separate statements regarding the certifications.)
□ Local Selection Committee - This is to certify that the local selection committee was structured as directed and complied with the current Policies and Procedures.
□ Eligibility Requirements - This is to certify that the nominee satisfies all eligibility criteria for the program as prescribed in the current Policies and Procedures. Note that an individual is only allowed to receive a Chancellor’s Award for Excellence once in five (5) years.
□ Compliance with Policies - This is to certify that this nomination complies with the current Policies and Procedures.
This form is also available online at: http://www.suny.edu/provost/academic_affairs/ChancellorsAwards.cfm
EXPLAIN BELOW ANY DEPARTURES FROM POLICY AS STATED IN THE CURRENT GUIDELINES.